It is an unfortunate fact that Alice's self-perception and its reinforcement by social and media images of age and aging is hardly unique. Older people, and especially those in retirement and care communities, tend to be perceived as old, frail, and unable to continue any sort of contribution to society. This tends to hasten the aging process and, in cases like Alice's, perpetuates a vicious cycle in which aging becomes a curse rather than the blessing that she was first to those around her and then to her husband.

According to Holstein, Parks, and Waymack (2011, p. 11), one important component of care giving and retirement communities is respecting the autonomy of older individuals by providing them with meaningful choice. This means that older people in such communities should be provided with choices that match their remaining cognitive and physical abilities.

When applied to Alice's case, her residence in the retirement community probably means that she is perceived as a person who no longer can or wishes to make meaningful contributions to society in terms of volunteer work. This has been gradually reinforced, first by her move away from the banana group and their active social roles to the mild friendships within the retirement community, and finally to the extreme isolation created by her care for her husband after his stroke. This isolation created for Alice a sense of loneliness that she did not perceive until after his death. All the meaning she derived from life during the last years with her husband derived from his care. Hence, her isolation from her social connections and roles were reinforced by her withdrawal from these connections.

To help Alice reestablish her sense of self-worth, more will be needed than simply calling her "pretty" or trying to convince her that she is still physically attractive. Alice's perception of her mirror image as an "old lady" should be recognized as far more than a physical condition. It is an emotional and spiritual condition...

The professionals who work with Alice should work to reinject her life with meaning by providing her with meaningful choice. Alice derives meaning from being involved with helping others. If she can be provided with such opportunities again, it is more than likely that her perception of her physical self will improve as well.
Alice's current report of her emotional state is predominantly emotional: she feels lonely, depressed, and hates her life. Her perception of her mirror image is merely a result of these feelings. The way that she talks about herself and her situation creates the impression that this is not her primary concern. Hence, Alice's inner state of mind should be the primary concern of those who care for her.

On possibility is to organize opportunities for Alice to become involved in volunteer work. Within the retirement community, she might, for example organize a group of able-bodied people to become involved in volunteer work in the surrounding community. This will not only reestablish her sense of usefulness to those around her, but will also reestablish the sense of connection and friendship that created meaning in her life until her husband's stroke.

In conclusion, when working with older people, it is vitally important to approach each case on individual merit and look for the causes of self-perception and aging in more than just the mirror image. While some can be "woken up" to how beautiful they remain physically regardless of a gradually deteriorating physique, many find their youth and sense of self-worth elsewhere than in physical beauty. The media and general social emphasis on physical beauty as equal to self-worth is but a very small component on what it really means to people like Alice to be useful and youthful in their communities.

Reference

Holstein, M.B., Parks, J.A., and Waymack, M.H. (2011). Ethics, Aging, and Society. New York: Springer Publishing Company.